The Medicaid and CHIP Payment and Access Commission (MACPAC) report focuses on improving the Medicaid beneficiary experience through Medical Care Advisory Committees (MCACs), increasing the transparency and improving the monitoring of the denials and appeals process in Medicaid managed care, and a review of hospital payment policy for...National News
Open to low-revenue accountable care organizations (ACOs) participating in the Medicare Shared Savings Program (MSSP), the CMS Innovation Center will test the five-year voluntary new model focused on primary care delivery starting in 2025.
The goals of the ACO PC Flex Model are to:
Expand access to high-quality, accountable care...White Papers, E books, Reports and more
A new study shows that nursing homes are hiding the bulk of their profits in order to bolster arguments for increased funding despite being unable to meet proposed quality standards or accept Medicare payment cuts.
The study, Tunneling and Hidden Profits in Health Care, was conducted by the University of California, Los Angeles...Arizona News
A valley law firm has sued the Arizona Health Care Cost Containment System (AHCCCS) for the wrongful death of two Navajo men who were targeted in the sober living home fraud scandal. Also, an Arizona legislator is pushing regulations that would increase oversight of sober living facilities in the state.
The lawsuit alleges that...Arizona News
Arizona's rate of cancer diagnoses is expected to climb over the next year, and although the industry has made strides in cancer care, partially supported by President Biden's Cancer Moonshot, physician retention issues pose a significant threat to providing adequate treatment for an increasing volume of patients.
Arizona is expected...CMS Rules
The Centers for Medicare and Medicaid Services (CMS) will end the Hospice Benefit Component of the Value-based Insurance Design (VBID) Model at the end of the year.
The hospice carve-in was designed to test coverage of hospice, palliative and transitional care coverage through the Medicare Advantage program. According to Hospice News,...
This week saw further fallout from the Change Healthcare cyberattack, this time affecting local Arizona providers and the Merit-based Incentive Payment System (MIPS) data submission window. On Wednesday, the HHS Office of Civil Rights (OCR) launched an investigation of Change Healthcare and UnitedHealth Group (UHG) focused on whether a...
President Joe Biden released his budget proposal this week which centers Medicare-boosting policies, lowering prescription drug prices and continuing subsidies to Affordable Care Act exchange insurers.
The president is pitching his $7.3 trillion budget for 2025 on the argument that it will curb national debt and reduce the deficit by...
According to researchers, from 2011 to 2020 Part D plans grew significantly more restrictive, rising from an average of about 32% of compounds restricted in 2011 to about 44% restricted in 2020. The prevalence of formulary exclusions also spread fast with Part D plan formularies excluding an average of nearly 45% of brand-name-only...
Over 12% of Part D enrollees faced copayments over $20 for a single fill of a generic drug. Fills for more than $2 were common, and accounted for nearly half of some prescriptions. The federal government has outlined plans for the Medicare $2 Drug List (M2DL) Model, which would create a high-value generic drug list that Part D drug plan...
The project is a complete interior remodel and expansion of the former Summit Center and according to the Northern Arizona non-profit health system, the new center is a reimagining of the outpatient environment originally envisioned at the Fort Tuthill wellness village Flagstaff voters rejected in November 2023.
The remodeling and...
A Maryland firm that oversees the nation’s largest independent network of primary care medical practices is facing a whistleblower lawsuit alleging it cheated Medicare out of millions of dollars using billing software “rigged” to make patients appear sicker than they were.
March 5, 2024
The civil suit alleges that Aledade...
Arizona's healthcare regulatory boards are under scrutiny following an ABC15 investigation that led to a bill's amendment.
At a House Health Committee meeting in February, Representative Selena Bliss (R-Prescott) told fellow legislators that she introduced HB 2686 in order to increase transparency from Arizona's health boards and...
On Monday, Governor Katie Hobbs announced a new program to cancel $2 billion in medical debt for Arizonans.
The governor announced the program upon signing a contract with nonprofit RIP Medical Debt, which buys debt held by collection agencies, medical providers and hospitals using grant funding. The agreement signs over $30 million...
This week Mesa police arrested a couple that was the target of an Internal Revenue Service (IRS) investigation into fraud against the Arizona Health Care Cost Containment System (AHCCCS) and related money laundering.
The Mesa police organized crime unit worked closely with the IRS field office, which currently has 13 open cases...
The U.S. Court of Appeals for the Fifth Circuit heard arguments in Braidwood v. Becerra, a case that would determine the future of the Affordable Care Act's (ACA) provision for private insurers to cover preventative care services.
Last year, a federal judge in Texas ruled that the ACA's requirement that employers cover vaccines,...
Home care companies are pushing back on Medicare Advantage plans in negotiations for better pay rates and service.
Companies like Addus HomeCare, Interim Healthcare and others are refusing to accept some patients enrolled in Medicare Advantage plans due to low reimbursement rates and issues with prior authorization processes. They...
The exact nature of the Change Healthcare cybersecurity incident remains mysterious as concerned parties come forward to voice concerns about Change, UnitedHealth Group and the use of healthcare technologies controlled by large companies.
Last Friday, Change Healthcare announced that it would offer a temporary assistance loan program...
Community Health Workers (CHWs) can now register as providers with the state's Medicaid agency, the Arizona Health Care Cost Containment System (AHCCCS), and be reimbursed for providing Medicaid services. Community Health Workers serve as important liaisons between health and social services and the community to facilitate access to...
In 2023, Arizona experienced its hottest summer since record keeping began more than 100 years ago. As the state's Chief Heat Officer, Eugene Livar, MD will oversee the implementation of Arizona Governor Katie Hobb's recently released Extreme Heat Preparedness Plan and work to coordinate partnerships between the state, county health...
Sources familiar with the DOJ interviews have reported to the Wall Street Journal that investigators are asking healthcare representatives in sectors where the insurer competes about the the relationship between UnitedHealthcare insurance unit and its Optum Health Services arm.
UnitedHealth revenue soared to $372 billion last year and...
The American Hospital Association (AHA) recently highlighted Abrazo Health's new NICU, which is now equipped to help newborns with complex maternal and neonatal medical conditions, as well as obstetric and fetal complications.
The 8,500 sq. ft. addition expanded the hospital's neonatal unit from 21 to 35 beds and is adjacent to Abrazo...
The Arizona Department of Health Services (ADHS) published the annual Maternal Mortality in Arizona report for 2018-2019 which showed a concerning increase in overall maternal mortality and disproportionate rates of maternal mortality among Black and Indigenous mothers.
According to the AZ DHS Report, national rates of maternal...
Congress has once again narrowly avoided a government shutdown after weeks-long negotiations with House Republicans.
On Wednesday evening, NPR reported that Senate Majority Leader Chuck Schumer, Senate Minority Leader Mitch McConnell and House Speaker Mike Johnson released a statement that they had reached an agreement on six of the...